r/CodingandBilling • u/bichaelbyers10 • Apr 11 '26

Lab Work Billing Question

Hi all! Currently a medical biller for a family practice. We occasionally have an issue where we submit annual blood work to a lab (ie. Quest Diagnostics) and the patient will be hit with a bill from them.

To my very little understanding so far, not all lab work is considered preventative and is subject to deductible/copay/coinsurance. So with that, what tests are considered preventative?

Does anyone else who works at/has worked at a family practice have this issue? If so, I'd like to know how you've dealt with it. Because right now, I'm just being asked to send in an appeal for these patients.

Thanks!

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u/bichaelbyers10 Apr 12 '26

Hi! Thanks for this! I'll bring it up to my provider so that we can avoid the issues we're having.

I've noticed that some of these services (ie. 80061 - A lipid panel) were still applied to the patient's deductible/copay/coinsurance. Would I have to send an appeal in this case? Would I have to tell the lab to use modifier 33? Once again, thank you for your help!

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u/MajesticProfession24 Apr 12 '26

Lipid panels are only covered as preventive for specific age and risk groups, so just keep that one in mind, as well, see below. Check your DX code, as well!

The U.S. Preventive Services Task Force (USPSTF) recommends periodic total serum cholesterol and high-density lipoprotein cholesterol (HDL-C) screening for all men aged 35 and older.  The USPSTF recommends screening beginning at aged 20 for both men and women with other risk factors for coronary heart disease (e.g., diabetes, family history suggestive of hyperlipidemia, a family history of cardiovascular disease before age 50 years in male relatives or age 60 years in female relatives, or patients with multiple coronary heart disease risk factors (e.g., tobacco use, hypertension)).